Syrian Healthcare Crisis: A Downward Spiral

FATIN TAWFIG

As the Syrian conflict enters its fifth year, with no resolution in sight, and the international community continuing to debate the best course of action, a severe healthcare crisis continues to escalate both in and around the war-torn country. The conflict began in 2011, when, amid the fervor of the Arab Spring, pro-democracy protests in the city of Deraa were violently repressed by government security forces. This led to the eruption of nationwide protests which sought the resignation of President Bashar al-Assad, eventually escalating into a civil war involving several different and overlapping factions: pro-regime versus opposition forces, the Sunni Muslim majority versus the Shia Alawite minority, and various jihadist groups.1

To date, over 200,000 people have been killed and over 12 million are in dire need of humanitarian assistance as a result of the ongoing conflict. Estimates of poverty levels within the country have risen to a horrifying 75%, 55% of whom cannot access basic survival necessities2. While these statistics help shed some light on the toll the war has taken on the country, they unavoidably mask the complexity of the situation. To gain some insight into the dynamics of the crisis, a deeper examination of the various issues facing the country’s healthcare network is necessary.

One dimension of the health crisis stems from the crumbling healthcare infrastructure in Syria. A contributing factor is the deliberate attack on health care facilities and workers by parties engaged in the conflict in direct violation of all four Geneva Conventions.3 Notwithstanding these commitments under international law, the Syrian government has perpetrated the vast majority of these attacks. Physicians for Human Rights (PHR) has blamed the Assad regime for “88 percent of the recorded hospital attacks and 97 percent of medical personnel killings, with 139 deaths directly attributed to torture or execution4.” With attacks on medical personnel steadily increasing over the course of the war, more and more Syrians are left without health care at the time when they most need it5.

This PHR report is only the latest in a long line of documents detailing the systematic abuse of medical care facilities in Syria by the Assad regime —facilities that are are supposed to represent safe havens from the dangers of the conflict. In 2011, only months after the initial protests and demonstrations were ruthlessly suppressed by the government, Amnesty International released a report calling attention to the detainment and assault of protesters in state-run hospitals, some of whom were denied medical care altogether.6 It is not surprising, then, that a factor exacerbating Syria’s health crisis is the rapid flight of doctors from the country, with more than half already gone as of early 2014. Besides fearing for their own safety, many Syrian doctors were forced to act contrary to the basic tenets of medical ethics and the Hippocratic Oath, signalling the rapid downfall of the medical infrastructure that “was once the envy of the Arab world7.”

Recently, Islamic State (ISIS) fighters have begun imposing fuel embargoes in parts of northern Syria, creating additional problems for the already resource-strapped medical facilities operating in those regions. As a result, various medical centers have been shut down and ambulances have been grounded, further reducing healthcare access in areas that are frequently ravaged by government barrel bombs8.

The collapsed health system affects the population as a whole, extending far beyond just those injured directly by hostilities. One example is the re-emergence of polio, effectively eradicated prior to the war, leaving hundreds of thousands of Syrian children vulnerable to the disease. 9 In order to control the spread of the disease, individuals working to vaccinate children in the country often have to do so in the face of open fire and other grave risks to their own safety10. In addition to 36 polio cases confirmed as of early March 2015 10, Syria has also seen 4,200 cases of measles and 6,500 cases of typhoid as of December 201411. This is in stark contrast to the pre-crisis status of the country – a “textbook example of how a government should combat infectious diseases12.”

Unfortunately, these examples only scratch the surface of the complex health care disaster in Syria that has spiralled out of control over the past four years. Pharmaceutical shortages, lack of access to clean water, and continuing indiscriminate chemical weapons attacks, to name a few, are still other factors that further increase the burden on a health care system that is already a shell of what it once was 12, 13, 14. As the international community looks on in horror at what has been termed the “biggest humanitarian crisis” of our time, it is necessary to recognize the increasing complexity of the current healthcare crisis so that a solution, appropriate to the scale and multifaceted nature of the issue, can be created as soon as possible 14.